Pediatric Renal Abscess: A 10-year Single-Center Retrospective Analysis

Abstract

Objective: The objective of this retrospective series is to describe the demographics and treatment of patients with renal abscesses and to determine if abscess size influences management. Methods: We reviewed all pediatric cases of renal abscesses treated over a 10-year period in our medical center. Clinical, laboratory, imaging data, and treatment modalities were analyzed. Results: Thirty-six patients were evaluated, with renal abscesses found in all age groups. The median age was 9.3 years, and 64% of patients affected were female. Fever and abdominal pain were the most common clinical symptoms. A premorbid genitourinary condition was present in 31% of patients. Previous urinary tract infection was documented in 31% of the cases. Initial elevation of C-reactive protein or erythrocyte sedimentation rate, when obtained, was observed in >80% of cases. Abnormal urinalysis was recognized in two-thirds of encounters. Escherichia coli, the most common microorganism isolated, was found in half the cases. Staphylococcus aureus was isolated in 11%. Ultrasound and computed tomography were the most used diagnostic imaging modalities. Eighty-nine percent of the patients who received intravenous antibiotics alone as an initial treatment regimen did not require percutaneous drainage or surgery. Conclusions: Ten of the 14 patients with an abscess size ≥3 cm had an invasive intervention, but only 1 of these 10 had an initial 48-hour trial of antibiotics alone. In contrast, only 2 of the 22 patients who had an abscess size <3 cm received an invasive intervention (Fisher P= .0002). We conclude that conservative treatment with intravenous antibiotics may be a reasonable initial approach.